DESCRIPTION (adapted from the application) There is a National crisis in patient-oriented research (POR) in Nephrology. At the same time that Nephrology patient populations are increasing, fewer and fewer physicians are pursuing careers in POR, largely because of a lack of mentoring and nurturing by experienced investigators. The long-term goal of this project is to mentor young investigators to become independent clinical researchers in Nephrology. The major thrust of this effort is to improve outcomes in patients with chronic renal diseases. In this amended application, I describe my program in POR which will be conducted in a unique environment made possible by collaborative efforts between myself, the University of Texas Southwestern Medical Center at Dallas (UTSW) and the Dallas Nephrology Associates (DNA), an academically oriented private nephrology group. I have assembled resources from both institutions to produce a strong, integrated patient-oriented research program in Nephrology. The resources include the Nephrology Division and Campus of UTSW and its patient population and the research environment, patient population and computerized patient database at DNA (> 10,000 patients with renal diseases). The patient populations at UTSW and DNA include large numbers of African-Americans and Hispanics that have very high rates of type II diabetes and are at very high risk for end-stage renal disease. In addition, I have added children to all of the new research projects proposed in this amendment. Furthermore, to facilitate this program I will return to the full-time faculty of UTSW as Director of Patient-Oriented Research in Nephrology on July 1, 2000 indicating my commitment and the Institution's commitment to conduct of and training in POR. My mentoring program, aimed at postdoctoral fellows (100 annual applicants) and young faculty in Nephrology has four key components: 1) Direct involvement in mentored clinical research projects with experienced investigators; 2) Curriculum in techniques of patient-oriented research; 3) Didactic courses in POR; and 4) Literature reviews, practical training in data collection, hypothesis generation and testing, manuscript preparation and grant writing. Also, trainees and junior faculty, will be strongly encouraged to pursue an option to enroll in the Masters in Public Health program at UTSW. Since my original grant was submitted, I successfully recruited two Nephrology fellows into this program. This grant will greatly assist me in developing my program by providing resources for ongoing and new research as well as for mentoring the next generation of clinical researchers in Nephrology.